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Optimising CPAP and oxygen levels to support spontaneous breathing in preterm rabbits

Ebony R Cannata1,2, Kelly J Crossley1,2, Erin V McGillick1,2

  • 1The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

Pediatric Research
|January 18, 2025
PubMed

Insights

Higher levels of continuous positive airway pressure (CPAP) and fraction of inspired oxygen (FiO2) improved breathing and lung aeration in preterm rabbits. This suggests that initial high CPAP and FiO2 may enhance respiratory support for newborns.

Area of Science:

  • Neonatal Physiology
  • Respiratory Medicine
  • Comparative Physiology

Background:

  • Very preterm infants often require respiratory support post-birth.
  • Current guidelines recommend continuous positive airway pressure (CPAP) of 4-8 cmH2O and fraction of inspired oxygen (FiO2) of 0.21-0.3.
  • Optimal respiratory support levels for preterm neonates remain to be determined.

Purpose of the Study:

  • To investigate the effects of varying CPAP and FiO2 levels on respiratory function in preterm rabbits.
  • To examine the interaction between high and low CPAP and FiO2 on breathing rates and lung aeration.

Main Methods:

  • Preterm rabbits (29/32 days gestation) were administered CPAP at 5 cmH2O or 15 cmH2O.
  • Fraction of inspired oxygen (FiO2) was set at either 0.3 or 0.6.
  • Breathing rates, functional residual capacity (FRC), lung bulging, and gastric air accumulation were measured using phase-contrast X-ray imaging.

Main Results:

  • Higher FiO2 (0.6) significantly increased breathing rates in both low and high CPAP groups compared to 0.3 FiO2.
  • A trend towards higher FRC was observed with 15 cmH2O CPAP and 0.6 FiO2.
  • No significant differences were found in lung bulging or air accumulation in the stomach across groups.

Conclusions:

  • Combined high CPAP (15 cmH2O) and high FiO2 (0.6) enhanced spontaneous breathing rates and lung aeration in preterm rabbits.
  • These findings suggest that higher initial CPAP and FiO2 levels, followed by titration, may improve respiratory support for preterm neonates.
  • The study indicates that elevated CPAP and FiO2 can be used without increasing risks of gastric distension or lung bulging.
Abstract

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